Biopsychosocial Factors Associated with Cigarette and E-cigarette Use in Smokers with Affective Disorders

摘要 情感障碍（AD，即，抑郁症和焦虑症），是最常见的心理健康 美国的条件。AD患者的吸烟率是普通人群的两倍。 人口有广告的吸烟者与没有广告的吸烟者一样多地尝试戒烟，但更多 在尝试戒烟时可能会复发。因此，患有AD的人患上了极高的 烟草相关疾病和死亡。2017年7月，美国食品和药物管理局（FDA）宣布， 烟草和尼古丁产品管制综合计划。该计划的一个基石是减少 美国政府将香烟中的尼古丁含量降至最低成瘾水平，以减少对烟草的依赖。 这个博士前奖学金促进健康相关研究多样性的父项目 (F31- 多样性）应用将建立一个随机临床试验，将检查是否非常低的尼古丁 内容香烟（VLNCC）降低AD吸烟者的吸烟率，以及是否提供电子烟 增强了这种效果。患有AD的吸烟者将被随机分配到以下条件之一，持续16周：（1） 仅正常尼古丁含量研究香烟（NNCC），（2）仅VLNCC，（3）VLNCC+烟草味 电子烟，或（4）VLNCC+优选口味的电子烟。根据以往的研究，我们预计， 随机分配到有或没有电子烟的VLNCC的参与者将部分但不完全取代这些研究 他们通常的香烟。此F31将在父授权的末尾添加单个会话， 可以使用VLNCC、电子烟和普通品牌香烟的参与者（即，条件3的人 和4）。候选人将（1）调查时间和社会环境背景，相对风险感知， 以及AD患者使用VLNCC、电子烟和常用品牌香烟的主观体验， (2)使用行为经济学交叉价格弹性任务来比较 VLNCC，电子烟和普通品牌香烟在AD患者中的作用，以及（3）调查参与者的 关于香烟尼古丁含量降低标准的意见，他们是否以及如何规避这种限制， 监管，以及电子烟的可用性是否会影响他们遵守这一规定的可能性 调控拟议的研究将帮助我们了解导致VLNCC，电子烟和 常见品牌香烟的使用与广告的吸烟者。反过来，这些知识可能有助于监管机构最大限度地提高 降低香烟尼古丁标准的有效性。

ABSTRACT Affective disorders (ADs, i.e., depression and anxiety disorders), are the most common mental health conditions in the US. The prevalence of smoking among people with ADs is twice that of the general population. Smokers with ADs make as many attempts to quit smoking as those without ADs, but are more likely to relapse during quit attempts. As a result, people with ADs suffer from disproportionately-high rates of tobacco-related disease and death. In July 2017, the Food and Drug Administration (FDA) announced a comprehensive plan for regulating tobacco and nicotine products. A cornerstone of this plan is to reduce the nicotine content of cigarettes to a minimally-addictive level, in order to reduce tobacco dependence in the US. The parent project upon which this Predoctoral Fellowship to Promote Diversity in Health-Related Research (F31 - Diversity) application will build is a randomized clinical trial that will examine whether very low nicotine content cigarettes (VLNCCs) reduce smoking rates in smokers with ADs, and whether providing e-cigarettes enhances this effect. Smokers with ADs will be randomized to one of the following conditions for 16 weeks: (1) normal nicotine content research cigarettes (NNCCs) only, (2) VLNCCs only, (3) VLNCCs + tobacco-flavored e-cigarettes, or (4) VLNCCs + preferred-flavor e-cigarettes. Based on previous research, we expect that participants randomized to VLNCCs with or without e-cigarettes will partially but not fully substitute these study products for their usual cigarettes. This F31 will add a single session at the end of the parent grant for participants who had access to VLNCCs, e-cigarettes, and usual-brand cigarettes (i.e., those in conditions 3 and 4). The candidate will (1) investigate temporal and social-environmental contexts, relative risk perceptions, and subjective experiences of VLNCC, e-cigarette and usual brand cigarette use among individuals with ADs, (2) use a behavioral economics cross-price elasticity task to compare the relative reinforcing effects of VLNCCs, e-cigarettes and usual-brand cigarettes among individuals with ADs, and (3) investigate participants’ opinions concerning a reduced-nicotine standard for cigarettes, whether and how they might circumvent such regulation, and whether the availability of e-cigarettes would affect the likelihood of their complying with this regulation. The proposed research will help us to understand factors contributing to VLNCC, e-cigarette and usual brand cigarette use in smokers with ADs. In turn, this knowledge may help regulators to maximize the effectiveness of a reduced-nicotine standard for cigarettes.